|
NPLATE 1MCG [250MCG VIAL]
|
Facility
|
IP
|
$15,003.96
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
25002353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,501.19 |
| Max. Negotiated Rate |
$14,403.80 |
| Rate for Payer: Aetna Commercial |
$11,553.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,703.09
|
| Rate for Payer: Cash Price |
$7,501.98
|
| Rate for Payer: Cigna Commercial |
$12,453.29
|
| Rate for Payer: First Health Commercial |
$14,253.76
|
| Rate for Payer: Humana Commercial |
$12,753.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,303.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,072.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,501.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,203.48
|
| Rate for Payer: Ohio Health Group HMO |
$11,252.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,003.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,053.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,352.73
|
| Rate for Payer: PHCS Commercial |
$14,403.80
|
| Rate for Payer: United Healthcare All Payer |
$13,203.48
|
|
|
NPLATE 1MCG [250MCG VIAL]
|
Facility
|
OP
|
$15,003.96
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
25002353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$14,403.80 |
| Rate for Payer: Aetna Commercial |
$11,553.05
|
| Rate for Payer: Anthem Medicaid |
$5,159.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,703.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.85
|
| Rate for Payer: Cash Price |
$7,501.98
|
| Rate for Payer: Cash Price |
$7,501.98
|
| Rate for Payer: Cigna Commercial |
$12,453.29
|
| Rate for Payer: First Health Commercial |
$14,253.76
|
| Rate for Payer: Humana Commercial |
$12,753.37
|
| Rate for Payer: Humana KY Medicaid |
$5,159.86
|
| Rate for Payer: Humana Medicare Advantage |
$11.00
|
| Rate for Payer: Kentucky WC Medicaid |
$5,212.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,303.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,072.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,263.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,203.48
|
| Rate for Payer: Ohio Health Group HMO |
$11,252.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,003.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,053.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,352.73
|
| Rate for Payer: PHCS Commercial |
$14,403.80
|
| Rate for Payer: United Healthcare All Payer |
$13,203.48
|
|
|
NPLATE 1MCG [500MCG VIAL]
|
Facility
|
OP
|
$30,007.81
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
25002354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$28,807.50 |
| Rate for Payer: Aetna Commercial |
$23,106.01
|
| Rate for Payer: Anthem Medicaid |
$10,319.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,406.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.85
|
| Rate for Payer: Cash Price |
$15,003.91
|
| Rate for Payer: Cash Price |
$15,003.91
|
| Rate for Payer: Cigna Commercial |
$24,906.48
|
| Rate for Payer: First Health Commercial |
$28,507.42
|
| Rate for Payer: Humana Commercial |
$25,506.64
|
| Rate for Payer: Humana KY Medicaid |
$10,319.69
|
| Rate for Payer: Humana Medicare Advantage |
$11.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10,424.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,606.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,145.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,526.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,406.87
|
| Rate for Payer: Ohio Health Group HMO |
$22,505.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,006.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,106.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,705.39
|
| Rate for Payer: PHCS Commercial |
$28,807.50
|
| Rate for Payer: United Healthcare All Payer |
$26,406.87
|
|
|
NPLATE 1MCG [500MCG VIAL]
|
Facility
|
IP
|
$30,007.81
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
25002354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,002.34 |
| Max. Negotiated Rate |
$28,807.50 |
| Rate for Payer: Aetna Commercial |
$23,106.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,406.09
|
| Rate for Payer: Cash Price |
$15,003.91
|
| Rate for Payer: Cigna Commercial |
$24,906.48
|
| Rate for Payer: First Health Commercial |
$28,507.42
|
| Rate for Payer: Humana Commercial |
$25,506.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,606.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,145.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,002.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,406.87
|
| Rate for Payer: Ohio Health Group HMO |
$22,505.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,006.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,106.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,705.39
|
| Rate for Payer: PHCS Commercial |
$28,807.50
|
| Rate for Payer: United Healthcare All Payer |
$26,406.87
|
|
|
NRPSYC TST EVAL PHYS/QHP 1ST
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 96132
|
| Hospital Charge Code |
51000050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Ambetter Exchange |
$101.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.69
|
| Rate for Payer: Anthem Medicaid |
$105.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.76
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$186.47
|
| Rate for Payer: Humana Medicaid |
$105.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.94
|
| Rate for Payer: Molina Healthcare Passport |
$105.82
|
| Rate for Payer: Multiplan PHCS |
$414.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.91
|
| Rate for Payer: UHCCP Medicaid |
$89.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.47
|
|
|
NRPSYC TST EVAL PHYS/QHP 1ST
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 96132
|
| Hospital Charge Code |
51000050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$686.36 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem Medicaid |
$237.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Humana KY Medicaid |
$237.29
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$239.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
NRPSYC TST EVAL PHYS/QHP 1ST
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 96132
|
| Hospital Charge Code |
51000050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
NRPSYC TST EVAL PHYS/QHP 1ST(P
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 96132
|
| Hospital Charge Code |
510P0050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$186.47 |
| Rate for Payer: Ambetter Exchange |
$101.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.69
|
| Rate for Payer: Anthem Medicaid |
$105.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.76
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$186.47
|
| Rate for Payer: Humana Medicaid |
$105.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.94
|
| Rate for Payer: Molina Healthcare Passport |
$105.82
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.91
|
| Rate for Payer: UHCCP Medicaid |
$89.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.47
|
|
|
NRPSYC TST EVAL PHYS/QHP 1ST(T
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 96132
|
| Hospital Charge Code |
510T0050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.20
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
NRPSYC TST EVAL PHYS/QHP 1ST(T
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 96132
|
| Hospital Charge Code |
510T0050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$686.36 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem Medicaid |
$130.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Humana KY Medicaid |
$130.68
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$132.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$133.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.20
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
IP
|
$2,312.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$2,219.52 |
| Rate for Payer: Aetna Commercial |
$1,780.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,803.36
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cigna Commercial |
$1,918.96
|
| Rate for Payer: First Health Commercial |
$2,196.40
|
| Rate for Payer: Humana Commercial |
$1,965.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,895.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,706.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$693.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,034.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,734.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,011.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,595.28
|
| Rate for Payer: PHCS Commercial |
$2,219.52
|
| Rate for Payer: United Healthcare All Payer |
$2,034.56
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Professional
|
Both
|
$2,312.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$183.91 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Ambetter Exchange |
$223.16
|
| Rate for Payer: Anthem Medicaid |
$206.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$267.79
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cigna Commercial |
$447.74
|
| Rate for Payer: Healthspan PPO |
$260.13
|
| Rate for Payer: Humana Medicaid |
$206.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$183.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$223.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.61
|
| Rate for Payer: Molina Healthcare Passport |
$206.48
|
| Rate for Payer: Multiplan PHCS |
$1,387.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.11
|
| Rate for Payer: UHCCP Medicaid |
$809.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.16
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
OP
|
$2,312.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$2,219.52 |
| Rate for Payer: Aetna Commercial |
$1,780.24
|
| Rate for Payer: Anthem Medicaid |
$795.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,803.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cigna Commercial |
$1,918.96
|
| Rate for Payer: First Health Commercial |
$2,196.40
|
| Rate for Payer: Humana Commercial |
$1,965.20
|
| Rate for Payer: Humana KY Medicaid |
$795.10
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$803.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,895.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,706.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$811.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,034.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,734.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,011.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,595.28
|
| Rate for Payer: PHCS Commercial |
$2,219.52
|
| Rate for Payer: United Healthcare All Payer |
$2,034.56
|
|
|
NRV CNDJ TEST 11-12 STUDIES(P
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
922P0016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$447.74 |
| Rate for Payer: Ambetter Exchange |
$223.16
|
| Rate for Payer: Anthem Medicaid |
$206.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$267.79
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$447.74
|
| Rate for Payer: Healthspan PPO |
$260.13
|
| Rate for Payer: Humana Medicaid |
$206.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$183.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$223.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.61
|
| Rate for Payer: Molina Healthcare Passport |
$206.48
|
| Rate for Payer: Multiplan PHCS |
$134.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.11
|
| Rate for Payer: UHCCP Medicaid |
$78.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.16
|
|
|
NRV CNDJ TEST 11-12 STUDIES(T
|
Facility
|
IP
|
$2,088.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
922T0016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$626.40 |
| Max. Negotiated Rate |
$2,004.48 |
| Rate for Payer: Aetna Commercial |
$1,607.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.64
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cigna Commercial |
$1,733.04
|
| Rate for Payer: First Health Commercial |
$1,983.60
|
| Rate for Payer: Humana Commercial |
$1,774.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.72
|
| Rate for Payer: PHCS Commercial |
$2,004.48
|
| Rate for Payer: United Healthcare All Payer |
$1,837.44
|
|
|
NRV CNDJ TEST 11-12 STUDIES(T
|
Facility
|
OP
|
$2,088.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
922T0016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$2,004.48 |
| Rate for Payer: Aetna Commercial |
$1,607.76
|
| Rate for Payer: Anthem Medicaid |
$718.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cigna Commercial |
$1,733.04
|
| Rate for Payer: First Health Commercial |
$1,983.60
|
| Rate for Payer: Humana Commercial |
$1,774.80
|
| Rate for Payer: Humana KY Medicaid |
$718.06
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$725.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.72
|
| Rate for Payer: PHCS Commercial |
$2,004.48
|
| Rate for Payer: United Healthcare All Payer |
$1,837.44
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Professional
|
Both
|
$3,103.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$218.05 |
| Max. Negotiated Rate |
$1,861.80 |
| Rate for Payer: Ambetter Exchange |
$261.39
|
| Rate for Payer: Anthem Medicaid |
$239.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$261.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$261.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.67
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$519.29
|
| Rate for Payer: Healthspan PPO |
$301.40
|
| Rate for Payer: Humana Medicaid |
$239.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$261.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.09
|
| Rate for Payer: Molina Healthcare Passport |
$239.30
|
| Rate for Payer: Multiplan PHCS |
$1,861.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$339.81
|
| Rate for Payer: UHCCP Medicaid |
$1,086.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$261.39
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$930.90 |
| Max. Negotiated Rate |
$2,978.88 |
| Rate for Payer: Aetna Commercial |
$2,389.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,420.34
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$2,575.49
|
| Rate for Payer: First Health Commercial |
$2,947.85
|
| Rate for Payer: Humana Commercial |
$2,637.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,730.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,327.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,482.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,699.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,141.07
|
| Rate for Payer: PHCS Commercial |
$2,978.88
|
| Rate for Payer: United Healthcare All Payer |
$2,730.64
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$2,978.88 |
| Rate for Payer: Aetna Commercial |
$2,389.31
|
| Rate for Payer: Anthem Medicaid |
$1,067.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,420.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$2,575.49
|
| Rate for Payer: First Health Commercial |
$2,947.85
|
| Rate for Payer: Humana Commercial |
$2,637.55
|
| Rate for Payer: Humana KY Medicaid |
$1,067.12
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,077.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,088.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,730.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,327.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,482.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,699.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,141.07
|
| Rate for Payer: PHCS Commercial |
$2,978.88
|
| Rate for Payer: United Healthcare All Payer |
$2,730.64
|
|
|
NRV CNDJ TEST 13/> STUDIES(P
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
922P0017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$519.29 |
| Rate for Payer: Ambetter Exchange |
$261.39
|
| Rate for Payer: Anthem Medicaid |
$239.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$261.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$261.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.67
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$519.29
|
| Rate for Payer: Healthspan PPO |
$301.40
|
| Rate for Payer: Humana Medicaid |
$239.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$261.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.09
|
| Rate for Payer: Molina Healthcare Passport |
$239.30
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$339.81
|
| Rate for Payer: UHCCP Medicaid |
$92.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$261.39
|
|
|
NRV CNDJ TEST 13/> STUDIES(T
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
922T0017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$851.40 |
| Max. Negotiated Rate |
$2,724.48 |
| Rate for Payer: Aetna Commercial |
$2,185.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,213.64
|
| Rate for Payer: Cash Price |
$1,419.00
|
| Rate for Payer: Cigna Commercial |
$2,355.54
|
| Rate for Payer: First Health Commercial |
$2,696.10
|
| Rate for Payer: Humana Commercial |
$2,412.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,327.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,094.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$851.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,497.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,128.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,469.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,958.22
|
| Rate for Payer: PHCS Commercial |
$2,724.48
|
| Rate for Payer: United Healthcare All Payer |
$2,497.44
|
|
|
NRV CNDJ TEST 13/> STUDIES(T
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
922T0017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$2,724.48 |
| Rate for Payer: Aetna Commercial |
$2,185.26
|
| Rate for Payer: Anthem Medicaid |
$975.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,213.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$1,419.00
|
| Rate for Payer: Cash Price |
$1,419.00
|
| Rate for Payer: Cigna Commercial |
$2,355.54
|
| Rate for Payer: First Health Commercial |
$2,696.10
|
| Rate for Payer: Humana Commercial |
$2,412.30
|
| Rate for Payer: Humana KY Medicaid |
$975.99
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$985.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,327.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,094.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$995.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,497.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,128.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,469.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,958.22
|
| Rate for Payer: PHCS Commercial |
$2,724.48
|
| Rate for Payer: United Healthcare All Payer |
$2,497.44
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Professional
|
Both
|
$1,471.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$122.74 |
| Max. Negotiated Rate |
$882.60 |
| Rate for Payer: Ambetter Exchange |
$159.01
|
| Rate for Payer: Anthem Medicaid |
$145.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$190.81
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cigna Commercial |
$315.34
|
| Rate for Payer: Healthspan PPO |
$183.12
|
| Rate for Payer: Humana Medicaid |
$145.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$159.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.23
|
| Rate for Payer: Molina Healthcare Passport |
$145.32
|
| Rate for Payer: Multiplan PHCS |
$882.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.71
|
| Rate for Payer: UHCCP Medicaid |
$514.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.01
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
IP
|
$1,471.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$441.30 |
| Max. Negotiated Rate |
$1,412.16 |
| Rate for Payer: Aetna Commercial |
$1,132.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,147.38
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cigna Commercial |
$1,220.93
|
| Rate for Payer: First Health Commercial |
$1,397.45
|
| Rate for Payer: Humana Commercial |
$1,250.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,206.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,085.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$441.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,294.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,103.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,279.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.99
|
| Rate for Payer: PHCS Commercial |
$1,412.16
|
| Rate for Payer: United Healthcare All Payer |
$1,294.48
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
OP
|
$1,471.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,412.16 |
| Rate for Payer: Aetna Commercial |
$1,132.67
|
| Rate for Payer: Anthem Medicaid |
$505.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,147.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cigna Commercial |
$1,220.93
|
| Rate for Payer: First Health Commercial |
$1,397.45
|
| Rate for Payer: Humana Commercial |
$1,250.35
|
| Rate for Payer: Humana KY Medicaid |
$505.88
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$511.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,206.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,085.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$516.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,294.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,103.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,279.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.99
|
| Rate for Payer: PHCS Commercial |
$1,412.16
|
| Rate for Payer: United Healthcare All Payer |
$1,294.48
|
|
